1
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The difficult parathyroid: advice to find elusive gland(s) and avoid or navigate reoperation. Curr Probl Surg 2023; 60:101262. [PMID: 36894218 DOI: 10.1016/j.cpsurg.2022.101262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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2
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Cavicchioli M, Bitencourt AGV, Lima ENP. 68Ga-DOTATATE PET/CT versus 111In-octreotide scintigraphy in patients with neuroendocrine tumors: a prospective study. Radiol Bras 2022; 55:13-18. [PMID: 35210659 PMCID: PMC8864693 DOI: 10.1590/0100-3984.2021.0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/11/2021] [Indexed: 01/15/2023] Open
Abstract
Objective To compare 68Ga-DOTA-DPhe1,Tyr3-octreotate
(68Ga-DOTATATE) positron-emission tomography/computed tomography
(PET/CT) findings with those of conventional 111In-octreotide
scintigraphy in patients with neuroendocrine tumors (NETs). Materials and Methods This was a single-center prospective study including 41 patients (25 males;
mean age, 55.4 years) with biopsy-proven NETs who underwent whole-body
111In-octreotide scintigraphy and whole-body
68Ga-DOTATATE PET/CT. The patients had been referred for tumor
staging (34.1%), tumor restaging (61.0%), or response evaluation (4.9%).
Images were compared in a patient-by-patient analysis to identify additional
lesions, and we attempted to determine the impact that discordant findings
had on treatment planning. Results Compared with 111In-octreotide scintigraphy,
68Ga-DOTATATE PET/CT revealed more lesions, the additional
lesions typically being in the liver or bowel. Changes in management owing
to the additional information provided by 68Ga-DOTATATE PET/CT
occurred in five patients (12.2%), including intermodal changes in three
(7.3%) and intramodal changes in two (4.9%). In addition,
68Ga-DOTATATE PET/CT yielded incidental findings unrelated to the
primary NET in three patients (7.3%): Hürthle cell carcinoma of the
thyroid, bowel non-Hodgkin lymphoma, and a suspicious breast lesion. Conclusion We conclude that 68Ga-DOTATATE PET/CT is superior to conventional
111In-octreotide scintigraphy for the management of NETs
because of its ability to determine the extent of the disease more
accurately, which, in some cases, translates to changes in the treatment
plan.
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3
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Stieb S, McDonald B, Gronberg M, Engeseth GM, He R, Fuller CD. Imaging for Target Delineation and Treatment Planning in Radiation Oncology: Current and Emerging Techniques. Hematol Oncol Clin North Am 2019; 33:963-975. [PMID: 31668214 DOI: 10.1016/j.hoc.2019.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Imaging in radiation oncology has a wide range of applications. It is necessary not only for tumor staging and treatment response assessment after therapy but also for the treatment planning process, including definition of target and organs at risk, as well as treatment plan calculation. This article provides a comprehensive overview of the main imaging modalities currently used for target delineation and treatment planning and gives insight into new and promising techniques.
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Affiliation(s)
- Sonja Stieb
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Brigid McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Mary Gronberg
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Grete May Engeseth
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Renjie He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Clifton David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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4
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Isaacs KE, Belete S, Miller BJ, Di Marco AN, Kirby S, Barwick T, Tolley NS, Anderson JR, Palazzo FF. Video-assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma. BJS Open 2019; 3:743-749. [PMID: 31832580 PMCID: PMC6887896 DOI: 10.1002/bjs5.50207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/28/2019] [Indexed: 11/30/2022] Open
Abstract
Background Primary hyperparathyroidism (PHPT), caused by an ectopic mediastinal parathyroid adenoma, is uncommon. In the past, when the adenoma was not accessible from the neck, median sternotomy was advocated for safe and successful parathyroidectomy. Video‐assisted thoracoscopic surgical (VATS) parathyroidectomy represents a modern alternative approach to this problem. Methods Information on patients undergoing VATS was obtained from a specific database, including clinical presentation, biochemistry, preoperative imaging, surgical approach and patient outcomes. A comprehensive literature review was undertaken to draw comparisons with other publications. Results Over a 2‐year period, nine patients underwent VATS parathyroidectomy for sporadic PHPT. Five patients had persistent PHPT following previous unsuccessful parathyroidectomy via cervicotomy, and four had had no previous parathyroid surgery. The median duration of surgery was 90 (range 60–160) min. Eight patients were cured biochemically, with no major complications. One patient required conversion to a median sternotomy for removal of a thymoma that had resulted in false‐positive preoperative imaging. Conclusion With appropriate preoperative imaging, multidisciplinary input and expertise, VATS parathyroidectomy is an effective, safe and well tolerated approach to ectopic mediastinal parathyroid adenoma.
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Affiliation(s)
- K E Isaacs
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK
| | - S Belete
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK
| | - B J Miller
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK
| | - A N Di Marco
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK.,Department of Surgery & Cancer Imperial College London UK
| | - S Kirby
- Department of Radiology Imperial College Healthcare NHS Trust London UK
| | - T Barwick
- Department of Anaesthesia Imperial College Healthcare NHS Trust London UK
| | - N S Tolley
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK.,Department of Surgery & Cancer Imperial College London UK
| | - J R Anderson
- Department of Cardiothoracic Surgery, Hammersmith Hospital Imperial College Healthcare NHS Trust London UK
| | - F F Palazzo
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK.,Department of Surgery & Cancer Imperial College London UK
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5
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Two decades of SPECT/CT - the coming of age of a technology: An updated review of literature evidence. Eur J Nucl Med Mol Imaging 2019; 46:1990-2012. [PMID: 31273437 PMCID: PMC6667427 DOI: 10.1007/s00259-019-04404-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/14/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE Single-photon emission computed tomography (SPECT) combined with computed tomography (CT) was introduced as a hybrid SPECT/CT imaging modality two decades ago. The main advantage of SPECT/CT is the increased specificity achieved through a more precise localization and characterization of functional findings. The improved diagnostic accuracy is also associated with greater diagnostic confidence and better inter-specialty communication. METHODS This review presents a critical assessment of the relevant literature published so far on the role of SPECT/CT in a variety of clinical conditions. It also includes an update on the established evidence demonstrating both the advantages and limitations of this modality. CONCLUSIONS For the majority of applications, SPECT/CT should be a routine imaging technique, fully integrated into the clinical decision-making process, including oncology, endocrinology, orthopaedics, paediatrics, and cardiology. Large-scale prospective studies are lacking, however, on the use of SPECT/CT in certain clinical domains such as neurology and lung disorders. The review also presents data on the complementary role of SPECT/CT with other imaging modalities and a comparative analysis, where available.
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6
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Stack BC, Tolley NS, Bartel TB, Bilezikian JP, Bodenner D, Camacho P, Cox JPDT, Dralle H, Jackson JE, Morris JC, Orloff LA, Palazzo F, Ridge JA, Scott-Coombes D, Steward DL, Terris DJ, Thompson G, Randolph GW. AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons. Head Neck 2018; 40:1617-1629. [PMID: 30070413 DOI: 10.1002/hed.25023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 10/13/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Revision parathyroid is challenging due to possible diagnostic uncertainty as well as the technical challenges it can present. METHODS A multidisciplinary panel of distinguished experts from the American Head and Neck Society (AHNS) Endocrine Section, the British Association of Endocrine and Thyroid Surgeons (BAETS), and other invited experts have reviewed this topic with the purpose of making recommendations based on current best evidence. The literature was also reviewed on May 12, 2017. PubMed (1946-2017), Cochrane SR (2005-2017), CT databases (1997-2017), and Web of Science (1945-2017) were searched with the following strategy: revision and reoperative parathyroidectomy to ensure completeness. RESULTS Guideline recommendations were made in 3 domains: preoperative evaluation, surgical management, and alternatives to surgery. Eleven guideline recommendations are proposed. CONCLUSION Reoperative parathyroid surgery is best avoided if possible. Our literature search and subsequent recommendations found that these cases are best managed by experienced surgeons using precision preoperative localization, intraoperative parathyroid hormone (PTH), and the team approach.
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Affiliation(s)
- Brendan C Stack
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Neil S Tolley
- Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, UK
| | | | - John P Bilezikian
- Department of Medicine, Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Donald Bodenner
- Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Pauline Camacho
- Department of Medicine, Division of Endocrinology, Loyola University, Chicago, Illinois
| | - Jeremy P D T Cox
- Department of Metabolic Medicine, Imperial College Hospital, NHS Healthcare Trust, London, UK
| | - Henning Dralle
- Sektion Endokrine Chirurgie, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinisches Zentrum, Germany
| | - James E Jackson
- Department of Imaging, Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, UK
| | - John C Morris
- Department of Medicine, Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Lisa Ann Orloff
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Fausto Palazzo
- Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, UK
| | - John A Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - David L Steward
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio
| | - David J Terris
- Department of Otolaryngology - Head and Neck Surgery, Augusta University, Augusta, Georgia
| | | | - Gregory W Randolph
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
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7
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Spanu A, Schillaci O, Piras B, Calvisi DF, Falchi A, Danieli R, Nuvoli S, Dore F, Madeddu G. Non-functioning gastroenteropancreatic (GEP) tumors: a 111In-Pentetreotide SPECT/CT diagnostic study. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2017; 7:181-194. [PMID: 28913157 PMCID: PMC5596321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/21/2017] [Indexed: 06/07/2023]
Abstract
In a retrospective study performed in non-functioning GEP tumor patients we further investigated 111In-Pentetreotide SPECT/CT usefulness in diagnosis, staging and follow-up also evaluating whether the procedure may give more information than conventional imaging procedures (CIP), such as CT, MRI, US. We enrolled 104 consecutive patients with non-functioning GEP tumors, 30 in initial diagnosis and staging phases (IDS) and 74 in follow-up (FU). All patients underwent somatostatin receptor scintigraphy (SRS) whole body scan at 4, 24 and, if necessary, 48 hours followed by abdominal and chest SPECT/CT after 111In-Pentetreotide 148-222 MBq i.v. injection. The patients previously underwent 2 to 3 CIP. At both CIP and SPECT/CT, 34/104 patients were classified as no evidence of disease (NED); in 70/104 patients, neoplastic lesions were ascertained and 12 IDS and 17 FU were classified as not operable and treated with octeotride or chemotherapy. SPECT/CT and CIP were concordantly positive in 44 patients, while only CIP was positive in 6 cases and only SPECT/CT in 20. Both per-patient sensitivity and accuracy of SPECT/CT (91.4 and 94.2%, respectively) were higher than CIP (71.4 and 80.8%, respectively), but not significantly. Globally, 292 lesions were ascertained: 141 hepatic, 78 abdominal extra-hepatic and 73 extra-abdominal. CIP detected 191/292 (65.4%) lesions in 50 patients, while SPECT/CT 244/292 (83.6%) in 64, the difference being significant (p<0.0001). No false positive results were found at both SPECT/CT and CIP. Both SPECT/CT sensitivity and accuracy were higher than CIP in G1, G2, neuroendocrine carcinoma (NEC) and mixed adeno-neuroendocrine carcinoma (MANEC) patients, but significantly only for G1. Globally, SPECT/CT incremental value than CIP was 35.6%. SPECT/CT correctly modified CIP classification and patient management in 27.9% of cases, while it down-staged the disease than CIP in 9.6% of cases. However, the two procedures combined use could achieve the highest accuracy value. 111In-Pentetreotide SRS, acquired as SPECT/CT, showing high sensitivity and accuracy values, more elevated than CIP in the present study, can still have a wide employment in the routine diagnostic protocol of non-functioning GEP tumors with significant impact on patient management and therapy planning. The procedure is simple to perform, has limited cost and wide availability in all Nuclear Medicine Centers.
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Affiliation(s)
- Angela Spanu
- Unit of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of SassariSassari, Italy
| | - Orazio Schillaci
- Unit of Nuclear Medicine, Department of Biomedicine and Prevention, University of Rome Tor VergataRome, Italy
| | - Bastiana Piras
- Unit of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of SassariSassari, Italy
| | - Diego F Calvisi
- Department of Clinical and Experimental Medicine, University of SassariSassari, Italy
| | - Antonio Falchi
- Unit of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of SassariSassari, Italy
| | - Roberta Danieli
- Unit of Nuclear Medicine, Department of Biomedicine and Prevention, University of Rome Tor VergataRome, Italy
| | - Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of SassariSassari, Italy
| | - Franca Dore
- Unit of Nuclear Medicine, University-Hospital of TriesteTrieste, Italy
| | - Giuseppe Madeddu
- Unit of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of SassariSassari, Italy
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8
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Padmanabhan P, Nedumaran AM, Mishra S, Pandarinathan G, Archunan G, Gulyás B. The Advents of Hybrid Imaging Modalities: A New Era in Neuroimaging Applications. ACTA ACUST UNITED AC 2017; 1:e1700019. [PMID: 32646180 DOI: 10.1002/adbi.201700019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/30/2017] [Indexed: 01/29/2023]
Abstract
Hybrid Imaging modalities have shown great potential in medical imaging and diagnosis. A more comprehensive and targeted view of neurological disorders can be achieved by blending the anatomical and functional perspectives through hybridization. With consistently improving technologies, there have been many developments in fused imaging techniques over the past few decades. This article provides an overview of various bimodal and trimodal hybrid imaging techniques being developed and explored for neuroimaging applications. Recent advancements and potentials are discussed for single photon emission computed tomography-computed tomography (SPECT-CT), positron emission tomography-CT (PET-CT), PET-magnetic resonance imaging (PET-MRI), electroencephalography-functional magnetic resonance imaging (EEG-fMRI), magnetoencephalography-fMRI (MEG-fMRI), EEG-near-infrared spectroscopy (EEG-NIRS), magnetic resonance-PET-EEG (MR-PET-EEG) and MR-PET-CT in the perspective of neuroimaging. A comparison of these hybrid approaches is provided on a single platform to analyze their performance on the basis of several common factors essential for imaging and analyzing neurological disorders and in vivo molecular processes. This article also provides an overview of recently developed advanced imaging technologies that are being hybridized with other imaging modalities and being explored as potential techniques for neuroscience. Novel approaches and clinical applications of hybrid neuroimaging are anticipated with inclusion of new technologies, better sensing capabilities, multimodal probes, and improved hybridization.
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Affiliation(s)
- Parasuraman Padmanabhan
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, 636921, Singapore
| | - Anu Maashaa Nedumaran
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, 636921, Singapore.,Department of Biomedical Engineering, SRM University, SRM Nagar, Kattankulathur, Kanchipuram, Tamil Nadu, 603203, India
| | - Sachin Mishra
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, 636921, Singapore
| | - Ganesh Pandarinathan
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, 636921, Singapore.,Department of Biomedical Engineering, SRM University, SRM Nagar, Kattankulathur, Kanchipuram, Tamil Nadu, 603203, India
| | - Govindaraju Archunan
- Centre for Pheromone Technology, Department of Animal Science, Bharathidasan University, Tiruchirappalli, 620024, India
| | - Balázs Gulyás
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, 636921, Singapore
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9
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Vicente EM, Lodge MA, Rowe SP, Wahl RL, Frey EC. Simplifying volumes-of-interest (VOIs) definition in quantitative SPECT: Beyond manual definition of 3D whole-organ VOIs. Med Phys 2017; 44:1707-1717. [PMID: 28207950 DOI: 10.1002/mp.12164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/23/2017] [Accepted: 02/02/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE We investigated the feasibility of using simpler methods than manual whole-organ volume-of-interest (VOI) definition to estimate the organ activity concentration in single photon emission computed tomography (SPECT) in cases where the activity in the organ can be assumed to be uniformly distributed on the scale of the voxel size. In particular, we investigated an anatomic region-of-interest (ROI) defined in a single transaxial slice, and a single sphere placed inside the organ boundaries. METHODS The evaluation was carried out using Monte Carlo simulations based on patient indium 111 In pentetreotide SPECT and computed tomography (CT) images. We modeled constant activity concentrations in each organ, validating this assumption by comparing the distribution of voxel values inside the organ VOIs of the simulated data with the patient data. We simulated projection data corresponding to 100, 50, and 25% of the clinical count level to study the effects of noise level due to shortened acquisition time. Images were reconstructed using a previously validated quantitative SPECT reconstruction method. The evaluation was performed in terms of the accuracy and precision of the activity concentration estimates. RESULTS The results demonstrated that the non-uniform image intensity observed in the reconstructed images in the organs with normal uptake was consistent with uniform activity concentration in the organs on the scale of the voxel size; observed non-uniformities in image intensity were due to a combination of partial-volume effects at the boundaries of the organ, artifacts in the reconstructed image due to collimator-detector response compensation, and noise. Using an ROI defined in a single transaxial slice produced similar biases compared to the three-dimensional (3D) whole-organ VOIs, provided that the transaxial slice was near the central plane of the organ and that the pixels from the organ boundaries were not included in the ROI. Although this slice method was sensitive to noise, biases were less than 10% for all the noise levels studied. The use of spherical VOIs was more sensitive to noise. The method was more accurate for larger spheres and larger organs such as the liver in comparison to the kidneys. Biases lower than 7% were found in the liver when using large enough spheres (radius ≥ 28 mm), regardless of the position, of the VOI inside the organ even with shortened acquisition times. The biases were more position-dependent for smaller organs. CONCLUSIONS Both of the simpler methods provided suitable surrogates in terms of accuracy and precision. The results suggested that a spherical VOI was more appropriate for estimating the activity concentration in larger organs such as the liver, regardless of the position of the sphere inside the organ. Larger spheres resulted in better estimates. A single-slice ROI was more suitable for activity estimation in smaller organs such as the kidneys, providing that the transaxial slice selected was near the central plane of the organ and that voxels from the organ boundaries were excluded. Under those conditions, activity concentrations with biases lower than 5% were observed for all the studied count levels and coefficients of variation were less than 9% and 5% for the 25% and 100% count levels, respectively.
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Affiliation(s)
- Esther M Vicente
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Martin A Lodge
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Steven P Rowe
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric C Frey
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, 21287, USA
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10
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Gill T, Adler K, Schrader A, Desai K, Wermers J, Beteselassie N. Extra-adrenal pheochromocytoma at the organ of Zuckerkandl: a case report and literature review. Radiol Case Rep 2017; 12:343-347. [PMID: 28491185 PMCID: PMC5417627 DOI: 10.1016/j.radcr.2016.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/01/2016] [Accepted: 12/19/2016] [Indexed: 11/25/2022] Open
Abstract
Pheochromocytomas and paragangliomas are tumors that occur in characteristic locations and are commonly detected on imaging studies. A correct diagnosis is important because of differences in associated neoplasms, risk for malignancy, and need for genetic testing. In addition, associated complications, including death, can be avoided if appropriately recognized and treated. Here, we report a rare case of an extra-adrenal paraganglioma of the organ of Zuckerkandl.
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Affiliation(s)
- Tarana Gill
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Corresponding author.
| | - Kalie Adler
- Diagnostic Radiology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Alicia Schrader
- Diagnostic Radiology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Keyur Desai
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Joshua Wermers
- Diagnostic Radiology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Nebiyu Beteselassie
- Diagnostic Radiology, University of Missouri-Kansas City, Kansas City, MO, USA
- Department of Radiology, Truman Medical Center, Kansas City, MO, USA
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11
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An Overview of Multimodal Neuroimaging Using Nanoprobes. Int J Mol Sci 2017; 18:ijms18020311. [PMID: 28157157 PMCID: PMC5343847 DOI: 10.3390/ijms18020311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/26/2017] [Indexed: 01/14/2023] Open
Abstract
Nanomaterials have gained tremendous significance as contrast agents for both anatomical and functional preclinical bio-imaging. Contrary to conventional medical practices, molecular imaging plays an important role in exploring the affected cells, thus providing precision medical solutions. It has been observed that incorporating nanoprobes improves the overall efficacy of the diagnosis and treatment processes. These nano-agents and tracers are therefore often incorporated into preclinical therapeutic and diagnostic applications. Multimodal imaging approaches are well equipped with nanoprobes to explore neurological disorders, as they can display more than one type of characteristic in molecular imaging. Multimodal imaging systems are explored by researchers as they can provide both anatomical and functional details of tumors and affected tissues. In this review, we present the state-of-the-art research concerning multimodal imaging systems and nanoprobes for neuroimaging applications.
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12
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Abstract
Chronic diarrhea is a frequently encountered symptom in clinical practice. The etiologies for chronic diarrhea are diverse and broad with varying clinical implications. A useful method of categorizing chronic diarrhea to guide a diagnostic work-up is a pathophysiology-based framework. Chronic diarrhea may be categorized as malabsorptive, secretory, osmotic, and inflammatory or motility related. Frequently, overlap between categories may exist for any given diarrhea etiology and diagnostic testing must occur with an understanding of the differential diagnosis. Investigations to achieve a diagnosis for chronic diarrhea range from screening blood and stool tests to more directed testing such as diagnostic imaging, and endoscopic and histological evaluation. The pathophysiology-based framework proposed in this chapter will allow the clinician to select screening tests followed by targeted tests to minimize cost and complications to the patient, while providing a highly effective method to achieve an accurate diagnosis.
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Affiliation(s)
- M Raman
- University of Calgary, Calgary, AB, Canada.
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13
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Maxwell JE, O'Dorisio TM, Howe JR. Biochemical Diagnosis and Preoperative Imaging of Gastroenteropancreatic Neuroendocrine Tumors. Surg Oncol Clin N Am 2015; 25:171-94. [PMID: 26610781 DOI: 10.1016/j.soc.2015.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Neuroendocrine tumors are a group of neoplasms that can arise in a variety of locations throughout the body and often metastasize early. A patient's only chance for cure is surgical removal of the primary tumor and all associated metastases, although even when surgical cure is unlikely, patients can benefit from surgical debulking. A thorough preoperative workup will often require multiple clinical tests and imaging studies to locate the primary tumor, delineate the extent of the disease, and assess tumor functionality. This review discusses the biomarkers important for the diagnosis of these tumors and the imaging modalities needed.
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Affiliation(s)
- Jessica E Maxwell
- Department of General Surgery, University of Iowa Hospitals and Clinics, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Thomas M O'Dorisio
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - James R Howe
- Department of General Surgery, University of Iowa Hospitals and Clinics, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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14
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Treglia G, Sadeghi R, Schalin-Jäntti C, Caldarella C, Ceriani L, Giovanella L, Eisele DW. Detection rate of 99m
Tc-MIBI single photon emission computed tomography (SPECT)/CT in preoperative planning for patients with primary hyperparathyroidism: A meta-analysis. Head Neck 2015; 38 Suppl 1:E2159-72. [DOI: 10.1002/hed.24027] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Giorgio Treglia
- Department of Nuclear Medicine; PET/CT and Thyroid Center, Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences; Mashhad Iran
| | - Camilla Schalin-Jäntti
- Division of Endocrinology; Abdominal Center, University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | | | - Luca Ceriani
- Department of Nuclear Medicine; PET/CT and Thyroid Center, Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - Luca Giovanella
- Department of Nuclear Medicine; PET/CT and Thyroid Center, Oncology Institute of Southern Switzerland; Bellinzona Switzerland
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Li Q, Pan J, Luo Q, Wang Y, Bao Y, Jia W. The key role of 99mTc-MIBI SPECT/CT in the diagnosis of parathyroid adenoma: a case report. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2015; 59:265-9. [DOI: 10.1590/2359-3997000000048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 09/25/2014] [Indexed: 11/22/2022]
Affiliation(s)
- Qing Li
- Shanghai Jiao Tong University, China
| | | | | | - Yan Wang
- Shanghai Jiao Tong University, China
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Maxwell JE, Howe JR. Imaging in neuroendocrine tumors: an update for the clinician. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2015; 2:159-168. [PMID: 26257863 DOI: 10.2217/ije.14.40] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Neuroendocrine tumors are a heterogeneous group of neoplasms that are best worked up and managed using a variety of clinical and imaging studies. They are often diagnosed after they have already metastasized, though this does not necessarily preclude an attempt at curative surgical treatment or surgical debulking. Tumor burden assessment often requires use of multiple imaging modalities including computed tomography, magnetic resonance imaging and ultrasound. Somatostatin receptor-based imaging is also of great utility in looking for primaries and determining the extent of metastatic disease. This paper will review the most common imaging modalities used in the diagnosis and treatment of neuroendocrine tumors.
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Affiliation(s)
- Jessica E Maxwell
- Department of General Surgery, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - James R Howe
- Department of General Surgery, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
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Schiller LR, Pardi DS, Spiller R, Semrad CE, Surawicz CM, Giannella RA, Krejs GJ, Farthing MJG, Sellin JH. Gastro 2013 APDW/WCOG Shanghai working party report: chronic diarrhea: definition, classification, diagnosis. J Gastroenterol Hepatol 2014; 29:6-25. [PMID: 24117999 DOI: 10.1111/jgh.12392] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2013] [Indexed: 02/06/2023]
Abstract
Diarrhea is best defined as passage of loose stools often with more frequent bowel movements. For clinical purposes, the Bristol Stool Form Scale works well to distinguish stool form and to identify loose stools. Laboratory testing of stool consistency has lagged behind. Acute diarrhea is likely to be due to infection and to be self-limited. As diarrhea becomes chronic, it is less likely to be due to infection; duration of 1 month seems to work well as a cut-off for chronic diarrhea, but detailed scientific knowledge is missing about the utility of this definition. In addition to duration of diarrhea, classifications by presenting scenario, by pathophysiology, and by stool characteristics (e.g. watery, fatty, or inflammatory) may help the canny clinician refine the differential diagnosis of chronic diarrhea. In this regard, a careful history remains the essential part of the evaluation of a patient with diarrhea. Imaging the intestine with endoscopy and radiographic techniques is useful, and biopsy of the small intestine and colon for histological assessment provides key diagnostic information. Endomicroscopy and molecular pathology are only now being explored for the diagnosis of chronic diarrhea. Interest in the microbiome of the gut is increasing; aside from a handful of well-described infections because of pathogens, little is known about alterations in the microbiome in chronic diarrhea. Serological tests have well-defined roles in the diagnosis of celiac disease but have less clearly defined application in autoimmune enteropathies and inflammatory bowel disease. Measurement of peptide hormones is of value in the diagnosis and management of endocrine tumors causing diarrhea, but these are so rare that these tests are of little value in screening because there will be many more false-positives than true-positive results. Chemical analysis of stools is of use in classifying chronic diarrhea and may limit the differential diagnosis that must be considered, but interpretation of the results is still evolving. Breath tests for assessment of carbohydrate malabsorption, small bowel bacterial overgrowth, and intestinal transit are fraught with technical limitations that decrease sensitivity and specificity. Likewise, tests of bile acid malabsorption have had limited utility beyond empirical trials of bile acid sequestrants.
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Calò PG, Pisano G, Tatti A, Loi G, Furcas S, Nicolosi A. Cervical lymph node sarcoidosis mimicking a parathyroid adenoma: a clinical case. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2013; 6:159-63. [PMID: 24250238 PMCID: PMC3825608 DOI: 10.4137/ccrep.s13026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We report a case of cervical lymph node sarcoidosis misdiagnosed as parathyroid adenoma. This is the second case described in the literature in which lymph node sarcoidosis was misdiagnosed as parathyroid adenoma on Tc-99m sestamibi (MIBI) scan, the first case localized in the neck. A 64-year-old woman presented with a hypercalcemia. Neck ultrasonography revealed a paratracheal hypoechoic mass of 15 mm with peripheral vascularization. MIBI scan and SPECT/CT identified a MIBI-positive area corresponding to the nodule detected by ultrasonography suggestive for a lower right parathyroid adenoma. A mass interpreted as the lower parathyroid was excised associated to a total thyroidectomy. Pathologic examination revealed a granulomatous lymph node consistent with active sarcoidosis. Sarcoidosis should be suspected as a cause of unexplained hypercalcemia and the differential diagnosis of hypercalcemia, even in presence of MIBI uptake, must include sarcoidosis localized in an isolated cervical lymph node.
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SPECT/CT and tumour imaging. Eur J Nucl Med Mol Imaging 2013; 41 Suppl 1:S67-80. [PMID: 23990144 DOI: 10.1007/s00259-013-2534-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 07/31/2013] [Indexed: 02/05/2023]
Abstract
Scintigraphic techniques are sensitive imaging modalities in the diagnosis and follow-up of cancer patients providing the functional and metabolic activity characteristics of the tumour. Hybrid SPECT/CT improves the diagnostic accuracy of these well-established imaging techniques by precise anatomical localization and characterization of morphological findings, differentiation between foci of physiological and pathological tracer uptake, resulting in a significant impact on patient management and more definitive interpretations. The use of SPECT/CT has been studied in a variety of applications in tumour imaging which are reviewed in this article. By combining functional and anatomical information in a single imaging session, SPECT/CT has become a one-stop cancer imaging modality.
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